Case Study: Maternal Diabetes in Pregnancy^[1]

Situation/Background

Mrs. Taylor, a 32-year-old woman, is 24 weeks pregnant with her second child. She has a history of type 2 diabetes mellitus, which was diagnosed five years ago. At her prenatal visit, her fasting blood glucose is 140 mg/dL, and her hemoglobin A1c is 7.8%. She reports feeling fatigued, experiencing frequent urination, and noticing occasional blurred vision. Her current medications include metformin, but she admits to occasional missed doses. Her diet consists of frequent fast-food meals due to her busy work schedule.

The health care provider orders dietary counseling, blood glucose monitoring, and potential insulin therapy.

Critical Thinking Questions

1. Which of the following fetal complications is Mrs. Taylor’s baby at risk for due to her uncontrolled diabetes?
   • a. Neural tube defects
   • b. Macrosomia
   • c. Placental abruption
   • d. Oligohydramnios
2. Mrs. Taylor asks why her provider is recommending insulin therapy when she is already on metformin. What is the best response by the nurse?
   • a. “Insulin is necessary because oral medications are not safe during pregnancy.”
   • b. “Insulin will help control your blood sugar more effectively because your levels are still high.”
   • c. “Metformin should be discontinued immediately, as it can harm your baby.”
   • d. “Your baby needs extra glucose to grow, so insulin is not needed unless your blood sugar drops too low.”
3. Which nursing intervention is the priority when educating Mrs. Taylor about managing her diabetes during pregnancy?
   
   • a. Encouraging an exercise routine with at least 60 minutes of activity per day
   • b. Advising her to avoid all carbohydrate intake to lower her blood sugar
   • c. Teaching her how to monitor her blood glucose levels regularly and adjusting her diet accordingly
   • d. Recommending that she increase her caloric intake to prevent hypoglycemia
4. Mrs. Taylor’s blood glucose levels remain elevated despite dietary changes and insulin therapy. For what potential complication should the nurse assess?
   • a. Preeclampsia
   • b. Hyperemesis gravidarum
   • c. Anemia
   • d. Rh incompatibility
5. During labor, Mrs. Taylor’s blood glucose is closely monitored. Why is this necessary?
   • a. To ensure the baby does not experience hypoglycemia after birth
   • b. To prevent an emergency C-section
   • c. To decrease the risk of postpartum hemorrhage
   • d. To avoid the need for pain medication during delivery
6. After delivery, Mrs. Taylor asks about her long-term diabetes management. What is the best nursing advice?
   • a. “Because pregnancy is over, your diabetes will return to normal without medication.”
   • b. “You may need less insulin now, but you should continue monitoring your blood sugar closely.”
   • c. “You will likely develop type 1 diabetes now that you’ve been on insulin.”
   • d. “Breastfeeding is not recommended because of your diabetes.”